Jamie Dupree

Reconciliation Bill Details

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Jamie Dupree
@ March 19, 2010 12:10 AM
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While I had a little fun in another blog with stuff that is in the Health Care Reconciliation bill, there are some big time changes made in provisions of the Senate passed health care bill that deserve attention. But you have to be a lawyer to figure some of them out.

I found the best way to do this was to use two computer screens, with the old Senate bill on one side and the new 153 pages of technical Reconciliation language on the other.

Overall, the bill would make the health care effort from Democrats cost $940 billion over ten years, producing $138 billion in defiict reduction. You can find that report on the web site of the Congressional Budget Office.

As for the legislative text - the place to start? Oh, that's easy - Subtitle E of Title I, dealing with "Provisions Relating to Revenue."

In other words, taxes and fees. This bill raises $438 billion in new tax revenue over ten years, most of it through higher Medicare taxes on high income earners.

* Sec. 1401. High-cost plan excise tax - this was the change in the "Cadillac" tax on high cost health care plans. It won't start until 2018, and will be at higher levels than originally approved in the Senate.

* Sec. 1402. Medicare tax - this imposes the Medicare tax for the first time on "net investment income" instead of just wages. If your modified adjusted gross income is more than $200,000/individual or $250,000/family, you get to fork over more to Uncle Sam. That would raise $210 billion over 10 years. Not only is investment income hit for upper income earners, but their rate also goes up on wages as well.

* Sec. 1403. Delay of limitation on health flexible spending arrangements under cafeteria plans - this would delay the new $2,500 limit on Flexible Spending Accounts until 2013.

* Sec. 1404. Brand name pharmaceuticals - the industry fee on drug makers is delayed until 2011, but the amount of money being brought in goes up by almost $5 billion to $27 billion

* Sec. 1405. Excise tax on medical device manufacturers - this tax is delayed until 2013; raises $20 billion.

* Sec. 1406. Health insurance providers - this fee on health insurance companies gets delayed for three years; raises $60 billion over ten years.

* Sec. 1407. Delay of elimination of deduction for expenses allocable to medicare part D subsidy - two year delay

* Sec. 1408. Elimination of unintended application of cellulosic biofuel producer credit - the "Black Liquor" issue limits the use of the tax credit to fuels that can be "used in a car engine or in a home heating application"; Google it if you want to read something interesting, as it will bring in $23.6 billion.

* Sec. 1409. Codification of economic substance doctrine and penalties - this one should make some lawyers perk up and take notice. It is a new revenue provision that denies "tax benefits when the transaction generating these tax benefits lacks economic substance." This brings in $4.5 billion in revenue over ten years.

Also, remember the tanning tax? The 10% excise tax on indoor tanning services is still alive. It would raise $2.7 billion over 10 years.

That's just some of the fun in the revenue section.

The more important part of this Reconciliation bill is can some of the provisions be knocked out in the Senate?

The answer seems to be yes - which could cause trouble there for this bill.

But I'm going to hold off on that until we see whether the House can pass the Senate health care bill.

That vote should come on Sunday.

Before I finish up, I want to also explore the Congressional Budget Office numbers on deficit reduction as a result of this health care plan.

The CBO report says that the plan would reduce the deficit by $138 billion over 10 years.

Of that $138 billion, only $85 billion is considered "on-budget" - by that, it means that it pertains to the budget and not to Social Security or other trust funds.

Of that $85 billion, $70 billion of that comes from premiums paid in for the CLASS Act, which is a new long term care entitlement program. Critics say the only reason it is in the black is because no one can make any claims from it until they pay in five years of premiums.

Another $10 billion in savings comes from the inclusion of the student loan reforms.

That leaves $5 billion in on-budget savings.

I'll let you make your own conclusions on the fine print. Leave me a comment and check back this weekend for the latest on the health care front in Congress.


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What others are saying

  • Reconciliation Bill - CBO ESTIMATES
    CBO reports are "preliminary estimates" only, extrapolated under extreme pressure from the House and President
    ( they water boarded CBO staffers ) to get the numbers "right"; jobs were at stake. The numbers were based on a set of assumptions developed from the 2000 US Census. The results of the 2010 census will not be available for at least 2 years (2010). It is likely that the number of uninsured beneficiaries and medicade ( under poverty line ) recipients will be 25% higher then CBO estimates based on the 2000 census, meaning the cost to the government
    ( Fed & States )will be 25% higher than preliminary estimates. Add to that the likely passage of immigration reform, which will add another 20 million to the beneficiary list by 2012. This means that the CBO "cost of program estimates" are off by 50%+, and the alleged deficit reduction by 2020 will be ZERO !!! Bottom line, the U.S. will go further in debt.
  • Reconciliation Bill - CBO ESTIMATES
    CBO report are "preliminary estimates" only, extrapolated under extreme pressure from the House and President ( they water boarded CBO staffers ) to get the numbers "right"; jobs were at stake. The numbers were based on a set of assumptions developed from the 2000 US Census. The results of the 2010 census will not be available for at least 2 years (2010). It is likely that the number of uninsured beneficiaries and medicade ( under poverty line ) recipients will be 25% higher then CBO estimates based on the 2000 census, meaning the cost to the government
    ( Fed & States )will be 25% higher than preliminary estimates. Add to that the likely passage of immigration reform, which will add another 20 million to the beneficiary list by 2012. This means that the CBO "cost of program estimates" are off by 50%+, and the alleged deficit reduction by 2020 will ZERO !!!
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